We report a case of developing multiple
adenocarcinoma foci in multiple hyperplastic
polyps in a patient with Helicobacter pylori
infection and hypergastrinemia during long-term
proton pump inhibitor (PPI)
therapy. A 57-year-old man, who was undergoing
hemodialysis for
chronic renal failure, underwent an upper gastrointestinal endoscopy to elucidate the cause of
anemia.
Atrophic gastritis with H. pylori
infection and multiple
adenocarcinoma foci in multiple hyperplastic
polyps were found in the endoscopic and histological examinations. Enterochromaffin-like micronests and parietal cell protrusion in the background of the
polyps suggested the existence of hypergastrinemia. The serum
gastrin level was markedly high-10,206 pg/ml (normal range 37-172 pg/ml). The cause of this marked hypergastrinemia was not autoimmune
gastritis and
gastrinoma. After discontinuing PPI
therapy and successful eradication of H. pylori, the serum
gastrin level decreased to normal range. These findings indicate that hypergastrinemia may be caused by long-term PPI
therapy in patients with H. pylori
infection. This case suggests that hypergastrinemia may mediate gastric
carcinogenesis in patients with H. pylori
infection.